| Objective:To investigate the effect of a domestic pedicle screw dynamic fixation stabilization system in adjacent segment degeneration after lumbar degenerative disease surgery,and to provide evidence for its further clinical application.Methods:Retrospective controlled study.From January 2019 to June 2020,the patients were admitted to the First Affiliated Hospital of Kunming Medical University for diagnosis of lumbar degenerative disease(lumbar disc herniation,lumbar spinal stenosis,lumbar spondylolisthesis),the patients who underwent posterior internal fixation were divided into three groups:Group A(single segment dynamic fixation group),Group B(Fusion Operation Group)and Group C(Fusion and dynamic fixation group).The clinical efficacy was assessed by Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)before operation and during follow-up;imaging data were obtained before operation and during follow-up,through Lumbar Lordosis(LL),Disk Height Index(DHI),DHI of the adjacent segment(DHI1),Intervertebral Angle(IV),IV of the adjacent segment(IV1),Range of Motion(ROM),ROM of the adjacent segment(ROM1),Pfirrmann classification of intervertebral disc degeneration and so on.A statistical analysis was performed to assess the effect of the dynamic fixation spine stabilization system on adjacent segment degeneration after lumbar degenerative disease surgery.Results:A total of 71 cases were included.There were 5 cases in Group A,26 cases in Group B,40 cases in Group C.There were too few cases in group A,statistical analysis alone might have large errors,so group A and C were combined as group AC.1 Clinical efficacyThe preoperative and postoperative VAS score of AC group decreased from 6.65±0.95 to 2.13±0.76 at the last follow-up,the preoperative and postoperative ODI score decreased from 67.6± 11.0 to 20.8±8.2 at the last follow-up,and the preoperative and postoperative VAS score of B group decreased from 6.83±0.93 to 2.18±0.71 at the last follow-up,The preoperative and postoperative ODI score decreased from 69.7±9.8 to 21.0 ± 8.1 at the last follow-up.Both groups had better clinical effects after surgery,and there was no difference between the groups.2 Image evaluation2.1 Lumbar lordosis:The preoperative,postoperative and eventual LL in AC group were 40.9±10.8,38.5±8.8 and 40.0±8.5,respectively.The preoperative,postoperative and eventual LL in Group B were 42.2 ± 15.0,40.1 ± 10.3 and 41.6±10.3,respectively.There was no statistical difference between the two groups of LL before and after surgery.2.2 Dynamic fixed segment(DHI,IV,ROM,Pfirrmann grading score):The preoperative,postoperative and eventual DHI in AC group increased from 0.36±0.09 to 0.40 ± 0.08 and then decreased to 0.36±0.09,IV decreased from 6.9±3.1 to 4.7±1.8 and then to 3.7±2.4,ROM decreased from 6.8± 1.4 to 3.6±0.7,Pfirrmann score decreased from 3.93±0.88 to 3.73 ± 0.96 at the last follow-up.The preoperative,postoperative and eventual DHI in Group B increased from 0.34±0.07 to 0.37±0.08,and then decreased to 0.32 ± 0.07,IV increased from 6.9±2.8 to 7.4±2.9 and then to 9.2±2.8.Compared with DHI,the preoperative,postoperative and eventual IV and ROM in AC group,there were significant differences,but the difference of preoperative and eventual DHI and Pfirrmann score were not statistically significant.The preoperative,postoperative and eventual DHI and IV in Group B were statistically significant.There was no significant difference between preoperative and postoperative IV.Postoperative and eventual IV was significant difference between groups.2.3 Dynamic fixation of the adjacent segment(DHI1,IV1,ROM1,Pfirrmannl grading score):In AC group,the preoperative,postoperative and eventual dynamic stabilization of DHI1 increased from 0.33±0.06 to 0.35±0.08,then decreased to 0.32 ±0.07,IV1 increased from 5.3±2.3 to 6.6±2.9 and then to 8.8 ±3.1,ROM1 increased from 5.8±1.7 to 8.7±3.7,and Pfirrmannl score increased from 2.40±0.91 to 2.67±0.90 at the last follow-up.The postoperative DHI1 were significantly different from preoperative and eventual DHI1.The preoperative,postoperative and eventual IV1,ROM1,and Pfirrmann1 were significantly different in AC group,but there was no significant difference between preoperative and eventual DHI1.Conclusions:(1)The dynamic fixation spine stabilization system in this study may achieve better clinical effects in short-middle stage follow-up.(2)The dynamic fixation spine stabilization system in this study can maintain the height of the intervertebral space,stabilize the fixed segment,retain some mobility,and delay the degeneration of the disc.(3)The dynamic fixation spine stabilization system in this study cannot avoid degenerative changes such as loss of intervertebral height,deterioration of stability,increased mobility,and aggravation of intervertebral disc degeneration in the adjacent segment. |
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